出血性视网膜脱离模型的建立

目的探索在兔眼建立出血性视网膜脱离（hemorrhagic retinal detachment，HRD）模型的方法，为HRD损害及其救治的研究奠定基础。方法14只健康青紫蓝兔 28只眼，随机分为HR D组（12只眼）和对照组（16只眼）。HRD组兔眼用特制的玻璃微管直视下经玻璃体腔在视网膜下注入自体抗凝血0.2 ml，造成HRD。对照组兔眼用同样方法在视网膜下注入0.2 ml 含肝素钠（2.5 U/ml）的生理盐水(肝素盐水对照组，6只眼)或生理盐水（盐水对照组，3只眼），形成视网膜脱离（retinal detachment，RD）。并建立假注射对照（单纯视网膜穿刺而不注射，3只眼）和正常对照（2只家兔的4只正常眼）。手术后1 h~28 d行直接检眼镜、光相干断层扫描（optical coherence tomography，OCT）、A和（或）B型超声检查以观察和分析视网膜脱离的发生和表现。结果手术后HRD组兔眼均发生HRD，视网膜明显隆起，范围为10～12个视盘直径（disc diameter, DD），持续约14 d，28 d 时仍可见视网膜下部分血液残留。肝素盐水及盐水对照组兔眼均发生RD，该RD仅在手术后12 h内明显。假注射对照组兔眼视网膜穿刺孔多在手术后2 d内消失，正常对照组兔眼视网膜无变化。结论经玻璃体腔在兔眼视网膜下注入自体抗凝血建立HRD动物模型的方法简便、实用、有效。（中华眼底病杂志，2003，19：175-178）     

兔眼出血性视网膜脱离后的超微结构变化

目的：观察兔出血性视网膜脱离（hemorrhagic retinal detachment,HRD）模型的超微结构变化。 方法：18只健康青紫蓝兔的36眼随机分为HRD组（视网膜下腔注入0．2mL自体抗凝血）和肝素盐水组（视网膜下腔注入0．2mL肝素盐水）。于HRD模型建立后1h;1,3,7,14和28d制作超薄切片,行透射电镜观察。 结果：HRD组透射电镜下,早期光感受器外节膜盘脱落、破碎,内节线粒体高度肿胀,随后光感受器外节脱落、消失,内节变性破碎,内外核层出现核固缩、核碎裂,细胞数目减少,14d后原注血区部分视网膜缺失。 结论：超微结构观察发现HRD对视网膜的损伤是涉及视网膜多层组织的严重的不可逆损害。     

出血性视网膜脱离后兔眼视网膜变化及凋亡相关基因bax在其中的表达

目的观察出血性视网膜脱离(hemorrhageretinaldetachment,HRD)对视网膜的影响和凋亡相关基因bax在其中的表达,探讨凋亡在出血性视网膜脱离中的作用。方法21只青紫蓝兔42眼,随机平均分为2组,实验组经玻璃体腔向视网膜下注入自体抗凝血0.2mL,对照组视网膜下注入含肝素钠生理盐水0.2mL。2只青紫蓝兔的4眼作为正常对照组。分别在手术后1h、1d、3d、7d、10d、14d、28d对视网膜进行常规HE染色切片,观察细胞丢失情况及测量视网膜神经感觉层厚度。采用免疫组化染色和原位杂交检测方法观察bax在视网膜中的表达情况。结果实验组10d、14d、28d的平均视网膜神经感觉层厚度、视网膜神经节细胞数明显小于对照组(P<0.05)。HRD后1～7d的bax表达显著,其中在3d达到峰值,实验组1d、3d、7d的bax阳性细胞较对照组明显增多(P<0.001)。结论HRD较单纯视网膜脱离的视网膜损害严重,且有时间依赖性和呈现递进的损伤过程,凋亡相关基因bax的表达说明凋亡可能是HRD视网膜损伤的重要机制。     

兔视网膜脱离后出现神经感觉层细胞凋亡

目的:研究实验性视网膜脱离(retinal detachment,RD)及脱离复位后神经感觉层细胞凋亡情况,探讨RD后视功能损害的机制为临床治疗提供理论基础。方法:健康成年无眼部疾病青紫兰兔40只,采用计算机随机数字表法分为RD后1,3h;1,3,7,14,28d组及正常对照组,共8组,每组5只,选取右眼为致伤眼,视网膜下注射透明质酸钠建立RD模型;分别于建立模型后按时获取兔眼标本,以TUNEL法观察视网膜神经感觉层细胞的凋亡情况。结果:视网膜脱离复位后存在着神经感觉层细胞凋亡现象,正常对照组、14d和28d组几乎不见凋亡细胞,脱离后1,3h;3,7d组在视网膜各细胞层均出现较多的、具有凋亡形态学与生化改变特征的凋亡细胞,其中在3d组视网膜感觉层细胞凋亡细胞数量达到高峰。视网膜神经感觉层凋亡细胞数目在1,3h;3,7d组之间两两比较均有显著性差异(P<0.01);1,3h;3,7d组与正常对照组、1h;1,28d组之间两两比较均有显著性差异(P<0.01);正常对照组、1h;14,28d组之间两两比较无显著性差异。结论:RD复位后,神经感觉层细胞发生凋亡。     

激光性黄斑病变的OCT图像特征

目的:观察激光导致的黄斑区视网膜损伤的眼底改变及其光学相干断层扫描仪(OCT)图像特征.方法:收集2002年4月-2009年12月因激光照射致视力下降的患者4例(4眼).所有患者均行眼部常规检查、眼底照相及OCT检查.结果:4例患者的眼底表现各不相同.1例表现为黄斑区板层裂孔,残留薄层外层视网膜,相应部位光感受器内外节连接光带消失及视网膜色素上皮光带消失,脉络膜光带下陷并反射略增强,周围视网膜前膜形成,玻璃体腔积血;1例表现为黄斑区全层裂孔伴周围视网膜水肿;1例表现为黄斑区视网膜神经上皮层局限性浆液性浅脱离;1例表现为黄斑区视网膜内层团状高反射(出血).结论:激光致黄斑区视网膜损伤的眼底表现多种多样,OCT能够清晰显示其视网膜损伤的层次及形态改变.     

相干光断层扫描在眼内肿瘤诊断中的临床应用

目的 研究相干光断层扫描（OCT）在多种眼内肿瘤诊断中的临床价值.设计回顾性系列病例.研究对象 49例（52眼）未行治疗的多种眼内肿瘤的OCT图像.方法 收集2006～2009年在北京同仁医院进行OCT检查（Zeiss StratusOCT Model 3000）的49例（52眼）未行治疗的眼内肿瘤的临床资料,对各种肿瘤的OCT图像进行分析.肿瘤诊断根据患者的典型症状、病史、跟底镜下表现并综合眼底血管造影、眼彩色多普勒超声检查、眼眶CT和MRI结果.其中14例脉络膜黑色素瘤及3例睫状体肿瘤在局部切除后病理检查确诊 2例脉络膜转移癌有明确原发恶性肿瘤.主要指标OCT图像表现.结果 42眼脉络膜肿瘤（脉络膜黑色素瘤27眼、脉络膜转移癌2眼、脉络膜血管瘤5眼、脉络膜骨瘤8眼）的OCT表现为瘤体处视网膜及色素上皮层（RPE）光带隆起,伴不同程度的反射强度改变及层次紊乱,光带后瘤体为暗区 瘤体局部（27眼）和黄斑部（27眼）可见视网膜神经上皮层脱离.视网膜内（下）高反射点仅见于脉络膜黑色素瘤,脉络膜骨瘤的RPE光带反射显著增强且极不规则.7眼视网膜肿瘤（视网膜星形细胞错构瘤2眼、视网膜血管瘤5眼）的OCT表现为视网膜光带隆起,反射强度不均匀,RPE光带不能显示 3眼可见黄斑区视网膜神经上皮层水肿、脱离.其中视网膜星形细胞错构瘤隆起的视网膜光带可见特殊的虫蚀样外观.3眼睫状体肿瘤（黑色素瘤1眼、无色素上皮腺瘤2眼）OCT未能扫描到瘤体,2眼黄斑部OCT正常,1眼黄斑部视网膜水肿伴神经上皮层浅脱离.结论 OCT可显示肿瘤继发性的瘤体局部和邻近的视网膜及黄斑部改变,在一定程度上提示肿瘤的性质帮助诊断.     

后部眼球壁灰褐色隆起物声像学诊断

目的：研究后部眼球壁灰褐色隆起物－脉络膜血肿及脉络膜黑色素瘤的声像学表现,以便对其进行声像学鉴别诊断。方法：对FFA确诊为脉络膜血肿和手术病理证实为脉络黑色素瘤的17例患者B超检查所见,进行声像学分析。结果：9例脉络膜血肿患者,B超检查表现为：6例后极部球壁局限性增厚,随增益降低出现层间透声裂隙,增益越低透声裂隙越明显,裂隙中散在弱回声光点;3例病变范围大、隆起高,与浅层视网膜脱离相似,但其光带较厚,缺乏后运动,且膜下见细小弱回声光点。8例脉络膜黑色素瘤中5例表现为球壁半球形实性隆起物,3例为蘑菇形。肿物在声像图上均表现为前缘光滑锐利,内回声前方多而强,向后渐少而弱,见脉络膜凹陷及后方声影,3例蘑菇形肿物均见头部周围及附近视网膜浅层脱离。结论：脉络膜血肿与脉络膜黑色素瘤的声像学表现有明显差异。     

20MHz B型超声与频域光学相干断层扫描在黄斑病变诊断中的对比观察

背景 黄斑区病变的形态学检查在疾病的早期诊断中发挥着重要作用.频域光学相干断层扫描(OCT)在屈光间质混浊眼的检查受到限制,传统的10 MHz B型超声检查对黄斑病变的分辨率较低,20 MHzB型超声检查在黄斑区疾病中的应用是一种新的方法. 目的 应用频域OCT和20 MHz B型超声对黄斑病变进行形态学对比观察,探讨20 MHz B型超声对黄斑疾病的临床诊断价值.方法 收集在天津医科大学眼科中心确诊的黄斑病变患者51例51眼,患眼均行频域OCT扫描,然后行20 MHz B型超声检查.黄斑病变按频域OCT检查的形态学改变进行分类,分析20 MHz B型超声的声像学特征,探讨病因. 结果 根据频域OCT检查检出黄斑裂孔 10眼,B型超声显示黄斑区实性圆顶状回声表浅隆起,病变中央呈孔状凹陷.频域OCT检出的黄斑水肿16眼、神经上皮层脱离6眼和视网膜劈裂4眼,B型超声均显示黄斑区球壁表面的局限性带状表浅隆起,其下见液性无回声间隙.频域OCT检出的视网膜色素上皮(RPE)层脱离15眼,B型超声检查显示黄斑区球壁表面局限带状强回声表浅隆起,光带较厚,其下见液性无回声间隙. 结论 20 MHz B型超声能对几种常见的黄斑病变进行初步鉴别,与频域OCT相比,黄斑病变B型超声表现的识别能力稍欠,但在屈光间质混浊的情况下,B型超声的诊断作用优于频域OCT.     

先天性黄斑缺损的相干光断层扫描图像分析

目的探讨先天性黄斑缺损的相干光断层扫描（OCT）图像特征,分析OCT对先天性黄斑缺损的诊断价值。方法回顾分析先天性黄斑缺损患者15例（20只眼）的眼底照片和OCT图像特征,进行分析总结。结果（1）OCT可显示后巩膜葡萄肿的范围和程度;（2）缺损区域脉络膜层毛细血管层光带消失;（3）缺损区域视网膜神经上皮层明显变薄,伴有神经上皮内外层间的分离,层间有低反射带;（4）缺损边缘紧密粘连;（5）缺损累及视盘时呈类似青光眼样视盘改变。结论OCT能够显示先天性黄斑缺损患者视网膜细微的形态学改变,结合眼底彩照可对该病进行全面而细致的评估。     

光学相干断层扫描对黄斑疾病的诊断意义

目的 评价光学相干断层扫描（optical coherence tomography,OCT)在诊断黄斑部疾病中的价值。方法 采用OCT检测了111例126只有黄斑部病变的眼：中心性浆液性脉络膜视网膜病变20眼，黄斑裂孔20眼，老年黄斑变性20眼，黄斑水肿26眼，视网膜前膜20眼，裂孔性视钢膜脱离累及黄斑部经手术复位后20眼。结果 黄斑部疾病的OCT示黄斑区视钢膜多种形态学改变。中心性浆液性脉络膜视网膜病挛 OCT见神经上皮层脱离和（或）色素上皮层脱离；黄斑裂孔的OCT见黄斑中心凹处神经上皮层全层或部分缺损，可伴神经上皮层脱离或增厚；湿性型年龄相关性黄斑变性的OCT见神经上皮层下呈不规则的高反射层（脉络膜新生血管膜），部分伴视网膜神经上皮层和（或）色素上皮层脱离；黄斑水肿及囊性水肿的OCT见黄斑区的神经上皮层厚度增厚和（或）层间液性囊腔；视网膜前膜的OCT见视网膜内层前有一高反射的光带；视网膜脱离术后的OCT见神经上皮层与色素上皮相贴良好或有液性腔隙存在。结论 OCT对黄斑部疾病诊断有独特的临床应用价值。     

Optical coherence tomography after photodynamic therapy for patients with pathologic myopia

PURPOSE: To evaluate early changes after photodynamic therapy (PDT) for patients with subfoveal choroidal neovascularization (CNV) due to pathologic myopia by optical coherence tomography (OCT). METHODS: PDT was performed on 10 eyes of 10 patients who presented with subfoveal CNV due to pathologic myopia. OCT was used to evaluate changes 1 day, 3 days, and 7 days after therapy. Changes in intraretinal and subretinal fluid and CNV were examined on the images obtained. The retinal elevation and the height of the neurosensory retinal detachment were calculated. From these two values, the thickness of the neurosensory retina was obtained. The thickness of the neurosensory retina was measured to ascertain the intraretinal fluid change, and the height of the neurosensory retinal detachment was measured to ascertain the subretinal fluid change. RESULTS: The mean pretherapy retinal elevation+/-SD increased from 211+/-28 microm to 230+/-39 microm 1 day after PDT and decreased to 221+/-36 microm 3 days after therapy. At 7 days after therapy, the mean retinal elevation+/-SD was 211+/-22 microm. The retinal elevation was due to a subretinal fluid accumulation, whereas the thickness of the neurosensory retina increased only to a minor extent (range, 0-22 microm) and the foveal architecture remained unchanged. The mean pretherapy height+/-SD of the neurosensory retinal detachment was 6+/-11 microm. It was 18+/-20 microm, 12+/-12 microm, and 3+/-6 microm 1 day, 3 days, and 7 days after therapy, respectively. No change in CNV was observed during follow-up. CONCLUSION: The results of our study indicate that the acute infiltration observed in patients with pathologic myopia after PDT occurs in the first day and regresses during the first week. Yet, it should be noted that, unlike in patients with age-related macular degeneration, the acute infiltration phase can be observed by OCT only to a limited extent.     

Differentiation of degenerative retinoschisis from retinal detachment using optical coherence tomography

OBJECTIVE: To assess the potential of optical coherence tomography (OCT) to differentiate retinoschisis from retinal detachment. Optical coherence tomography is a noninvasive, noncontact imaging method that produces high-resolution, cross-sectional images of ocular tissue. DESIGN: Retrospective case series. PARTICIPANTS: Thirteen eyes of 12 patients with the differential diagnosis of retinoschisis versus retinal detachment. METHODS: Differentiation between retinoschisis and retinal detachment was established from both ophthalmoscopic and OCT examinations. MAIN OUTCOME MEASURE: Ability of OCT to differentiate retinoschisis from retinal detachment was measured. RESULTS: Thirteen eyes of 12 patients with retinal elevation were examined with OCT. The cross-sectional view produced by OCT was effective in distinguishing retinoschisis from retinal detachment. Optical coherence tomography images of retinoschisis show a splitting of the neurosensory retina. The OCT images of retinal detachment show separation of full-thickness neurosensory retina from the retinal pigment epithelium band. The OCT images correlated with the clinical impression in all 13 cases. CONCLUSIONS: Based on this series of cases, OCT is a potentially useful new test that may be used to distinguish retinoschisis from rhegmatogenous retinal detachment.     

视网膜中央静脉阻塞黄斑损害的光学相干断层扫描图像观察

目的 观察视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)所致黄斑损害的光学相干断层扫描(optical coherence tomography,OCT)检查的图像特征。 方法 38例经间接检眼镜和荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查确诊的CRVO患者接受了OCT检查。所有操作集中在黄斑区，以通过中心凹的等长度和等角度间隔的4线扫描为基础，并依据个体情况进行改变扫描线长度、角度及扫描方式的附加扫描。 结果 15只眼表现为黄斑中心凹囊泡样改变，6只眼表现为黄斑区神经上皮脱离，11只眼黄斑区神经上皮不同程度增厚，4只眼黄斑中心凹形态大致正常，神经上皮层间有细小液性暗腔，2只眼神经上皮显著增厚，层间大量液性腔隙，黄斑前膜组织增生。 结论 CRVO黄斑损害的主要OCT图像特征为黄斑囊样水肿、神经上皮脱离以及继发黄斑前膜和色素上皮的改变。了解这些特征性改变有助于对CRVO黄斑损害的诊断和评估。 (中华眼底病杂志, 1999, 15: 201-204)     

Optical coherence tomography of the neurosensory retina in rhegmatogenous retinal detachment

PURPOSE: To clarify the pathologic changes of the detached neurosensory retina in rhegmatogenous retinal detachment. METHODS: Retinal images were prospectively examined by optical coherence tomography in 25 eyes of 25 consecutive patients with rhegmatogenous retinal detachment. We excluded the patients whose retinal detachment did not involve the central fovea or patients with poor fixation during optical coherence tomography (OCT) examination. Optical coherence tomography was scanned through the center of the fovea. The patients ranged in age from 15 to 77 years (mean, 45 years; SD, 20 years). The period from onset of subjective symptoms of retinal detachment to OCT ranged from 2 to 60 days (mean, 16 days; SD, 18 days). Optical coherence tomography findings, best-corrected visual acuity, and the height of the retinal detachment at the central fovea were statistically analyzed using ANCOVA (analysis of covariance) and the Mann-Whitney U test. RESULTS: In 25 eyes of 25 patients, OCT of the detached neurosensory retina at and adjacent to the center of the fovea demonstrated normal retinal structure (10 eyes, 40%), intraretinal separation (7 eyes, 28%), and an undulated separated outer retina (8 eyes, 32%). Three statistically significant factors affected best-corrected visual acuity: intraretinal separation (P = .001), intraretinal separation with undulated outer retina (P = .001), and height of retinal detachment at the central fovea (P<.001). Best-corrected visual acuity was significantly worse in the 15 eyes with intraretinal separation with or without an undulated outer retina than in the 10 eyes with retinal thickening but no intraretinal separation (P = .036). The eight eyes with undulated separated outer retina showed significantly higher retinal detachment at the central fovea than the seven eyes with intraretinal separation but no undulated outer retina (P = .009) and the 10 eyes without intraretinal separation (P = .016). The duration from onset of subjective symptoms to OCT was not related to the occurrence of intraretinal separation of the detached retina. CONCLUSIONS: Intraretinal separation of the detached retina occurred frequently and shortly after retinal detachment in rhegmatogenous retinal detachment and was one of the factors associated with poor vision in rhegmatogenous retinal detachment. Best-corrected visual acuity significantly decreased in the highly detached retina.     

孔源性视网膜脱离手术前黄斑改变的光学相干断层扫描检查

目的　观察孔源性视网膜脱离手术前黄斑改变的光学相干断层扫描图像的特征。方法　用光学相干断层扫描检测 6 2例 6 2眼孔源性视网膜脱离患者的双眼手术前黄斑形态改变。以通过黄斑中心凹的 6mm长度和等角度间隔的四线扫描为基础 ,并根据个体情况作改变扫描线长度和角度的附加扫描。结果　孔源性视网膜脱离术前的光学相干断层扫描图像 ,根据黄斑改变分为 3类 :( 1)黄斑附着 2 9眼 ,表现为神经感觉层脱离未波及黄斑 ;( 2 )黄斑部分脱离 5眼 ,包括神经感觉层囊样水肿 2眼 ,伴玻璃体粘连 3眼 ;( 3)黄斑完全脱离2 8眼 ,包括神经感觉层水肿呈网状 18眼 ,视网膜劈裂 3眼 ,黄斑裂孔 5眼 ,以及伴视网膜前膜 2眼。结论　光学相干断层扫描能详细提供孔源性视网膜脱离术前的黄斑形态改变特征 ,这非常有助于对黄斑病变的检查和视力预后评估。     

视网膜脱离复位后的光学相干断层照像

观察视网膜脱离复位后的光学相干断层扫描 (opticalcoherencetomography ,OCT)。方法 :34例波及黄斑部的孔源性视网膜脱离复位后的患者分别于术后 3天、 1月、 2月、 3月、 4月、 5月、 6月进行OCT观察 6个月。结果 :术后 3天所有病例均残留程度不等的视网膜下液 ;术后 6月 ,共复位 14例 ( 3例视网膜呈水肿样增厚 ,2例变性 ,1例视网膜下出现新生血管 ,1例黄斑囊样水肿 ,继而发展成黄斑裂孔 ) ;2 0例视网膜下仍有少量残留液体。结论 :OCT可从微观角度直接客观的在活体上检测视网膜的复位状况及组织结构。 (波及黄斑部的 )孔源性视网膜脱离复位后的视网膜下仍有少量残留液体 ,残留液体的长期存在影响术后视功能的恢复。